Denials Management Specialist

Definition and Role

The Denial Management Specialist is responsible for monitoring denials, appeals, and resolutions from participating insurance carriers and working proactively to collect from insurance carriers.  We’re looking for talented, compassionate, qualified professionals who will embrace our culture of excellence, service, integrity and innovation. 

Job Responsibilities and Duties

  • Researches and analyzes denial data and coordinate denial recovery responsibilities.
  • Identifies, analyzes, and researches frequent root causes of denials and develops corrective action plans for resolution of denials
  • Develop reporting tools that effectively measure and monitor processes throughout the denials management process in order to support process improvement.
  • Prioritizes activities to work overturns in a timely manner to alleviate untimely filings
  • Uses reports that categorize denials to assign tasks or personally work to overturn denials
  • Identifies and pursues opportunities for improvements in denial performance
  • Processes work lists to facilitate prompt intervention of insurance denials
  • Researches, responds, and documents insurer and patient correspondence/inquiry notes regarding coding coverage, benefits, and reimbursement on patient accounts
  • Researches rejections included in EOBs for resolution and files appropriately

Qualifications

  • Excellent written and verbal skills are required as well as outstanding interpersonal skills
  • Demonstrated understanding of medical terminology required
  • Knowledge of patient confidentiality and HIPAA regulations
  • Knowledge of CPT, HCPCS, and ICD10 coding required.
  • Knowledge of medical billing and collection practices
  • Understands Medicare and Medical Assistance regulations as they apply to job functions
  • Experience with electronic health records (EHR/EMR) or healthcare related computer systems
  • Practices efficient methods for getting work done; strong ability to prioritize workload
  • Organized; sets priorities; meets deadlines
  • Ability to work independently

 

 

 

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